Identification of a novel human papillomavirus by metagenomic analysis of vaginal swab samples from pregnant women
© The Author(s). 2016
Received: 18 May 2016
Accepted: 1 July 2016
Published: 4 July 2016
The number of members in the genus Gammapapillomavirus of Family Papillomaviridae has recently been expanding most rapidly. The aim of this study was to characterize a novel human gammapapillomavirus type identified in a vaginal swab from a 25-year-old pregnant woman suffering from vaginitis.
Viral metagenomics method was used to detect the viral sequences in 88 vaginal swab samples collected from 88 pregnant women with vaginitis. A novel papillomavirus, named HPV-ZJ01 (GenBank no. KX082661), was detected in one sample and its complete genome sequence was amplified by PCR and sequenced by Sanger walking. Phylogenetic analyses based on the complete genome and the L1 protein of HPV-ZJ01 and other representative human papillomaviruses were done, respectively. Further PCR screening was performed in vaginal swabs (n = 135), cervical smears (n = 40) and cervical cancer tissues (n = 40) using nested-PCR primers designed based on HPV-ZJ01 sequence to investigate the prevalence of HPV-ZJ01.
The genome of HPV-ZJ01 is 7,358 bp in length with a GC content of 37.8 %. HPV-ZJ01 was predicted to contain six open reading frames (E6, E7, E1, E2, L2, and L1) and a non-coding long control region (LCR). The genome shared the highest overall similarity to HPV-166, with 70.6 % nucleotide sequence identity while its L1 gene shared the highest nucleotide similarity to HPV-162, with 71.1 % sequence identity. Phylogenetic analysis suggested that HPV-ZJ01 belongs to a novel HPV type in the Gamma-PV genus, species Gamma-19, already containing HPV161, HPV162 and HPV166. PCR screening results indicated that none of the other samples were positive for HPV-ZJ01 except the original HPV-ZJ01 positive vaginal swab specimen.
The genome sequence of a novel type of species Gamma-19 HPV was characterized. The screening PCR results suggested that HPV-ZJ01 is not associated with any of the cervical cancer samples tested. In order to confirm the prevalence and disease association, if any, for HPV-ZJ01, a further study with different sample types and a larger sample size is needed.
Human papillomaviruses (HPVs) belong to family Papillomaviridae, with small, circular, double-stranded DNA genomes . Papillomaviruses are highly diverse and infect human epithelial cells, where some species are implicated in the development of several benign and malignant neoplasms [1, 2]. Based on the nucleotide similarity in the L1 open reading frame (ORF), HPVs are classified into genera, species and types [1, 3]. HPV types that display less than 60 % nucleotide sequence similarity in the L1 open reading frame (ORF) are classified into different genera, while viral species share 60–70 % nucleotide sequence similarity, and types show at least 90 % . The taxonomy of papillomaviruses at the species level and above is overseen by the International Committee for the Taxonomy of Viruses; while, HPV type designation and classification below the species level is maintained by the International HPV Reference Center at the Karolinska Institute, Stockholm, Sweden . As of May 6, 2016, two hundred and one different HPV types, ranging from HPV-1 to HPV-205, were officially recognized, including 65 Alphapapillomaviruses (Alpha-PVs), 51 Betapapillomaviruses (Beta-PVs), 81 Gammapapillomaviruses (Gamma-PVs), 3 Mupapillomaviruses (Mu-PVs), and a single Nupapillomavirus (Nu-PV) . Four previously recognized HPV types (HPV-46, HPV-55, HPV-64 and HPV-79) were recently re-classified as subtypes (HPV-79 was replaced by HPV91) [6–8].
As more HPV types are discovered, it is necessary to confirm the genomic characteristics and the clinical relevance of these new HPV types. Although a variety of laboratory techniques for detecting known HPVs are available, an efficient laboratory method for the identification of divergent HPVs from different biological samples is required.
Viral metagenomics is a useful method that can non-specifically detect both already known and highly divergent viruses. Non capsid protected host-derived background DNA and RNA in biological samples can be digested by nuclease treatment and nucleotide sequence information from viral particles associated nucleic acids determined by sequence-independent amplification and deep sequencing to allows the identification of viruses recognizable through their nucleotide or translated protein sequence homologies to all known viruses. With the advent of viral metagenomics [9–12] and the use of rolling circle amplification (RCA) which preferentially amplifies DNA circles [13, 14], it becomes possible to obtain the complete genome of new HPVs at relatively high speed.
In the present study, a viral metagenomic method was applied to vaginal swab samples collected from pregnant women, and identified a novel gamma papillomavirus in a sample from a 25-year-old pregnant woman suffering from vaginitis. We describe here the genome and phylogenetic analysis of this novel Gamma-PV type. Type-specific PCR primers were also developed to test a representative collection of various clinical specimens.
Sample collection and metagenomic analysis
From Jan. 2014 to Jan. 2015, 88 vaginal swab specimens were collected from 88 pregnant women with vaginitis in the affiliated Maternity and Infant Hospital of Jiangsu University, China. Swab specimens were re-suspended in 500ul of phosphate-buffered saline (PBS) and vigorously vortexed for five min. The suspension of each sample was subjected to centrifugation (10 min, 15,000 × g). The supernatant was filtered through a 0.45-μm filter (Millipore) to remove eukaryotic and bacterial cell-sized particles. The filtrates enriched in viral particles were treated with DNase and RNase to digest unprotected nucleic acid at 37 °C for 60 min . Remaining total nucleic acid was then isolated using QiaAmp Mini Viral RNA kit (Qiagen) according to manufacturer’s protocol. Six separate pools were randomly generated, 5 of which contained nucleic acid from 15 specimens while one included 13 specimens. Six libraries were then constructed using Nextera XT DNA Sample Preparation Kit (Illumina) and sequenced using the MiSeq Illumina platform with 250 bases paired ends with dual barcoding for each pool. Bioinformatics analysis was performed according to a previous study .
Finding and genome sequencing of the novel HPV
nested primers used to detect the positive sample of HPV-ZJ01 and amplify the gaps between contigs
Sequence (5′to 3′)
Sequence (5′to 3′)
In order to assess the prevalence of HPV-ZJ01 and whether this novel HPV strain was associated with cervical carcinoma, PCR was performed to screen the original 88 vaginal swab specimens, plus 128 samples from 128 patients suffering from cervical carcinoma, including 40 cancer tissues, 40 cervical smears, and 48 vaginal swab specimens, collected in 2014–2016 from the affiliated Maternity and Infant Hospital of Jiangsu University, China. All samples were frozen immediately at −80 °C until further processing. Before nucleic acid extraction, tissue samples were homogenized, frozen and thawed on dry ice three times. Nucleic acids were extracted by QiaAmp Mini Viral RNA kit (Qiagen). Two sets of PCR screening primers were designed based on the genome sequence of HPV-ZJ01 (Table 1). Standard precautions were used for all procedures to reduce the possibility of sample contamination by amplified DNA molecules. Negative and positive controls were included from nucleic acid extraction to PCR screening. The original HPV positive swab sample identified in this study was used as positive control. PBS was used as negative control instead of samples during nucleic acid extraction, while deionized water was used as negative control instead of nucleic acid template in PCR screening.
Phylogenetic analyses were performed including the closest viral relatives based on best BLASTx hits and representative members of related viral species and genera. Sequence alignment was performed using CLUSTALW with the default settings. A phylogenetic tree with 1000 bootstrap resamples of the alignment data sets was generated using the maximum likelihood method based on Jones-Taylor-Thornton (JTT) model in MEGA6.0. Bootstrap values (based on 1000 replicates) for each node are given. Putative ORFs in the genome were predicted by NCBI ORF finder. Informed consents were provided by all participants included in the present study. Ethical Approval was given by Ethics Committee of Jiangsu University and the reference number is No. JSU2015045.
Nucleotide sequence accession numbers
The genome sequence of HPV-ZJ01 was deposited in GenBank under the accession number: KX082661.
We identified the characteristic donor (AAG/GUASNR) and acceptor (GUYACYAG/YU) RNA splicing sites [13, 24–26] and it is likely that the E4 protein is translated from a spliced mRNA, containing the first few codons of the E1 ORF joined to the E4 sequence (Fig. 1, E1^E4, coding sequence consisting of genomic positions nt 709–727 and 3,061-3,398), as described previously for other HPV types [13, 24–26]. The resulting putative E1^E4 fusion protein contains a typically high content of proline, with 13 proline residues out of 118 amino acids (11 %).
Sequence and phylogenetic analysis
Identity of HPV-ZJ01 Amino Acid Sequences with Related HPVs
PCR screening result
PCR screening results indicated that except the original HPV-ZJ01 positive vaginal swab specimen, none of the other vaginal swabs (n = 135), cervical smears (n = 40) and cervical cancer tissues (n = 40) samples were positive.
The advent of metagenomics using high-throughput sequencing technology [9–12] facilitates the discovery of novel viruses at a relatively low cost and unprecedented speed, assists in the study of viral diversity, and the association of virus and disease [28–30]. We report here the genome of HPV-ZJ01, a novel human gammapapillomavirus type identified from a vaginal swab sample of a pregnant woman, whose L1 gene shares 71.1 % nucleotide identity with that of HPV162, its closest relative. Phylogenetic analysis confirmed that HPV-ZJ01 clusters with other Gammapapillomaviruses in species 19 (HPV161, HPV162 and HPV166), all of them containing the typical HPV ORFs, coding for four putative early proteins (E6, E7, E1, E2), and two late capsid proteins (L2 and L1). Due to the presence of the characteristic donor (AAG/GUASNR) and acceptor (GUYACYAG/YU) RNA splicing sites in E1 and E2 ORFs, respectively [13, 24–26], from HPV-ZJ01, HPV161, HPV162 and HPV166, it is most likely that the E4 proteins of these four HPVs are translated from a spliced mRNA, containing the first few codons of the E1 ORFs joined to the E4 sequence. The resulting putative E1^E4 fusion proteins contain a typically high content of proline, which represents 11 %, 13.27 %, 10 % and 10 % of E1^E4 amino acid sequences of HPV-ZJ01, HPV161, HPV162, and HPV166, respectively.
Analysis of genome organization of HPV-ZJ01, HPV161, HPV162 and HPV166 revealed that they share many similarities and some differences. Two conserved zinc-binding domains of CxxC(x)29CxxC separated by 36 amino acids are found at the same position away from the N-terminal end of E6 protein of these four HPVs, respectively. Additionally, the E7 proteins of them also contain a single zinc-binding domain of CxxC(x)29CxxC at the same position, respectively. The putative LXCXE motif found in the E7 protein of HPV-ZJ01, also identified in the three HPVs of Gamma genus, species 19 is a canonical pRB-binding motif and has been implicated in the transformation of host cells [21, 31, 32]. A homologous LXCXE motif is used to bind to the pocket region of pRB, P107 and P130 and prevent inter-actions with the transcription factor E2F-1 by most HPV E7 proteins . The E1 of HPV-ZJ01 contains the conserved ATP-binding site of the ATP-dependent helicase (GPPDSGKS), nevertheless, in comparison, the motif is GPPDTGKS in all of the other three HPVs, with the Serine being replaced by Threonine. The putative E2 protein of HPV-ZJ01 contains no conserved leucine-zipper domain (L-X6-L-X6-L-X6-L), necessary for E2 dimerization. This domain is also missing in HPV161, 162 and 166. In the LCR of both HPV-ZJ01 and HPV161, a putative TATA box (TATAAA) of the E6 promoter is identified 36 and 34 nt upstream of the first start codon of the E6 ORF, respectively, while the classical TATA box (TATAAA) was not detected in the LCR of HPV162 and HPV166. Similarly, three and two E1 binding sites (AACAAT) are found in the LCR of HPV-ZJ01 and HPV161, respectively, while none is detected in the LCR of HPV162 and 166. As for the polyadenylation sites, the LCR of HPV-ZJ01 and HPV162 each contain one and HPV161 and HPV166 each contain two. Notably, for HPV161, its LCR simply contains two copies of the 12-basepair palindrome motif ACCG-N4-CGGT, known to play a crucial role in binding of the E2 protein [18, 19]. However, in the other three HPVs (HPV-ZJ01, HPV162, HPV166), both palindrome sites (ACCG-N4-CGGT) and degenerate palindrome sites (ACC-N6/7-GGT) are simultaneously present in their LCRs. HPV-ZJ01 contains two palindrome sites (ACCG-N4-CGGT) and three degenerate palindrome sites (ACC-N6/7-GGT) in its LCR, while the LCR of HPV162 only contains one palindrome site (ACCG-N4-CGGT), and the other three E2 binding sites are represented by the degenerate ones (ACC-N6-GGT). Only one palindrome site (ACCG-N4-CGGT) and four degenerate palindrome sites (ACC-N6-GGT) are in the LCR of HPV166.
HPV types have traditionally been classified as mucosal or cutaneous on the assumption that HPV tissue tropism is reflected in the location where the genome of the particular type was found [13, 34]. Accordingly, HPV types belonging to the Alpha-PVs are predominantly assigned as anogenital types and Beta-PVs, Gamma-PVs, Mu-PVs and Nu-PVs as cutaneous types [2, 34]. However, a growing body of evidence suggests that HPV types belonging to Gamma-PVs (the genus whose known members has recently been expanding most rapidly) are ubiquitous and show broader tissue tropism than previously thought , with reported detection sites ranging from healthy skin and various cutaneous lesions [35–38] to genital lesions  and oral  and nasal  mucosa. One recent report suggests that Gamma-PVs are also able to infect mucocutaneous sites such as the anal canal  and even the possibility of dual tropism of Gamma HPVs was recently proposed . Here, HPV-ZJ01, confirmed to be a member of Gamma-PV genus, species 19 and identified in a vaginal swab can be preliminarily classified as mucosal. However, as its closest relatives (HPV161, HPV162 and HPV166) were isolated from healthy skin , the tropism of HPV-ZJ01 remains to be definitely established as different PV types classified in a specific species typically share biological and pathological properties . The 25-year-old pregnant woman in whom we identified HPV-ZJ01 was suffering from vaginitis. Whether the presence of HPV-ZJ01 was at all related to this condition or indirectly facilitated viral replication is not known. No skin or mucosal lesion was noted by the attending gynecologist. In humans, cutaneous HPVs are highly prevalent in the general population, where they usually are contained by the immune system and result in subclinical infections. These infections however tend to become clinically apparent upon genetic, acquired, or iatrogenic deficiencies in cell-mediated immunity, and cutaneous HPVs have been linked to non-melanoma skin cancer in these patients .
Here we screened total 216 samples including vaginal swabs, cervical carcinoma tissues and cervical smears from cervical carcinoma patients using PCR methods. The negative PCR results suggested that HPV-ZJ01 may not be associated with cervical cancer. Further studies with different sample types and a larger sample size are needed to clarify the prevalence and disease association, if any, for HPV-ZJ01.
A novel HPV type named HPV-ZJ01 was identified in a vaginal swab sample from a 25 years old pregnant woman with vaginitis and its genome was characterized. Comparative characterization of HPV-ZJ01 and its closest relatives and phylogenetic analysis demonstrated that it is a novel HPV type and clusters into the Gamma-PV genus, species Gamma-19. No evidence of disease association of the new HPV type was found.
Alpha-PVs, Alphapapillomavirus; Beta-PVs, Betapapillomavirus; DNase, deoxyribonuclease; Gamma-PVs, Gammapapillomavirus; HPV, human papillomavirus; ICTV, International Committee on Taxonomy of Viruses; LCR, non-coding long control region; Mu-PVs, Mupapillomavirus; NCBI, National Center for Biotechnology Information; nt, nucleotide; Nu-PVs, Nupapillomavirus; ORF, open reading frame; PBS, phosphate-buffered saline; PCR, polymerase chain reaction; PV, papillomavirus; RCA, rolling circle amplification; RNase, Ribonuclease; URR, upstream regulatory region.
This work was partly supported by the National Natural Science Foundation of China No. 31302107, the Natural Science Foundation of Jiangsu Province No. BK20140537 and BK20130502, and China Postdoctoral Special Foundation No. 2015 T80503, Jiangsu University funds for youth backbone teacher No. 201300X. The funding bodies didn’t participate in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.
WZ conceived the study. WZ and ZL performed most of the experiments. ZL wrote the paper. All authors participated in part of the experiments, did proof-reading, and approved the final manuscript.
The authors declare that they have no competing interests.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
- Bernard HU, Burk RD, Chen Z, van Doorslaer K, Zur HH, de Villiers EM. Classification of papillomaviruses (PVs) based on 189 PV types and proposal of taxonomic amendments. Virology. 2010;401:70–9.View ArticlePubMedPubMed CentralGoogle Scholar
- Cubie HA. Diseases associated with human papillomavirus infection. Virology. 2013;445:21–34.View ArticlePubMedGoogle Scholar
- de Villiers EM, Fauquet C, Broker TR, Bernard HU, Zur HH. Classification of papillomaviruses. Virology. 2004;324:17–27.View ArticlePubMedGoogle Scholar
- Bzhalava D, Eklund C, Dillner J. International standardization and classification of human papillomavirus types. Virology. 2015;476:341–4.View ArticlePubMedGoogle Scholar
- International Human Papillomavirus Reference Center. http://www.hpvcenter.se/html/refclones.html. Accessed 6 May 2016.
- Terai M, Burk RD. Identification and characterization of 3 novel genital human papillomaviruses by overlapping polymerase chain reaction: candHPV89, candHPV90, and candHPV91. J Infect Dis. 2002;185:1794–7.View ArticlePubMedGoogle Scholar
- Kremsdorf D, Favre M, Jablonska S, Obalek S, Rueda LA, Lutzner MA, Blanchet-Bardon C, Van Voorst VP, Orth G. Molecular cloning and characterization of the genomes of nine newly recognized human papillomavirus types associated with epidermodysplasia verruciformis. J Virol. 1984;52:1013–8.PubMedPubMed CentralGoogle Scholar
- Delius H, Hofmann B. Primer-directed sequencing of human papillomavirus types. Curr Top Microbiol Immunol. 1994;186:13–31.PubMedGoogle Scholar
- Riesenfeld CS, Schloss PD, Handelsman J. Metagenomics: genomic analysis of microbial communities. Annu Rev Genet. 2004;38:525–52.View ArticlePubMedGoogle Scholar
- Edwards RA, Rohwer F. Viral metagenomics. Nat Rev Microbiol. 2005;3:504–10.View ArticlePubMedGoogle Scholar
- Delwart EL. Viral metagenomics. Rev Med Virol. 2007;17:115–31.View ArticlePubMedGoogle Scholar
- Mokili JL, Rohwer F, Dutilh BE. Metagenomics and future perspectives in virus discovery. Curr Opin Virol. 2012;2:63–77.View ArticlePubMedGoogle Scholar
- Ure AE, Forslund O. Characterization of human papillomavirus type 154 and tissue tropism of gammapapillomaviruses. PLoS One. 2014;9, e89342.View ArticlePubMedPubMed CentralGoogle Scholar
- Martin E, Dang J, Bzhalava D, Stern J, Edelstein ZR, Koutsky LA, Kiviat NB, Feng Q. Characterization of three novel human papillomavirus types isolated from oral rinse samples of healthy individuals. J Clin Virol. 2014;59:30–7.View ArticlePubMedGoogle Scholar
- Zhang W, Li L, Deng X, Kapusinszky B, Delwart E. What is for dinner? Viral metagenomics of US store bought beef, pork, and chicken. Virology. 2014;468–470:303–10.View ArticlePubMedGoogle Scholar
- Deng X, Naccache SN, Ng T, Federman S, Li L, Chiu CY, Delwart EL. An ensemble strategy that significantly improves de novo assembly of microbial genomes from metagenomic next-generation sequencing data. Nucleic Acids Res. 2015;43, e46.View ArticlePubMedPubMed CentralGoogle Scholar
- Chen G, Stenlund A. The E1 initiator recognizes multiple overlapping sites in the papillomavirus origin of DNA replication. J Virol. 2001;75:292–302.View ArticlePubMedPubMed CentralGoogle Scholar
- Krubke J, Kraus J, Delius H, Chow L, Broker T, Iftner T, Pfister H. Genetic relationship among human papillomaviruses associated with benign and malignant tumours of patients with epidermodysplasia verruciformis. J Gen Virol. 1987;68(Pt 12):3091–103.View ArticlePubMedGoogle Scholar
- Androphy EJ, Lowy DR, Schiller JT. Bovine papillomavirus E2 trans-activating gene product binds to specific sites in papillomavirus DNA. Nature. 1987;325:70–3.View ArticlePubMedGoogle Scholar
- Spalholz BA, Yang YC, Howley PM. Transactivation of a bovine papilloma virus transcriptional regulatory element by the E2 gene product. Cell. 1985;42:183–91.View ArticlePubMedGoogle Scholar
- Dahiya A, Gavin MR, Luo RX, Dean DC. Role of the LXCXE binding site in Rb function. Mol Cell Biol. 2000;20:6799–805.View ArticlePubMedPubMed CentralGoogle Scholar
- Radulescu RT, Bellitti MR, Ruvo M, Cassani G, Fassina G. Binding of the LXCXE insulin motif to a hexapeptide derived from retinoblastoma protein. Biochem Biophys Res Commun. 1995;206:97–102.View ArticlePubMedGoogle Scholar
- Titolo S, Pelletier A, Sauve F, Brault K, Wardrop E, White PW, Amin A, Cordingley MG, Archambault J. Role of the ATP-binding domain of the human papillomavirus type 11 E1 helicase in E2-dependent binding to the origin. J Virol. 1999;73:5282–93.PubMedPubMed CentralGoogle Scholar
- Kovanda A, Kocjan BJ, Potocnik M, Poljak M. Characterization of a novel cutaneous human papillomavirus genotype HPV-125. PLoS One. 2011;6, e22414.View ArticlePubMedPubMed CentralGoogle Scholar
- Hosnjak L, Kocjan BJ, Pirs B, Seme K, Poljak M. Characterization of two novel gammapapillomaviruses, HPV179 and HPV184, isolated from common warts of a renal-transplant recipient. PLoS One. 2015;10, e119154.View ArticleGoogle Scholar
- Ostrbenk A, Kocjan BJ, Hosnjak L, Li J, Deng Q, Sterbenc A, Poljak M. Identification of a Novel Human Papillomavirus, Type HPV199, Isolated from a Nasopharynx and Anal Canal, and Complete Genomic Characterization of Papillomavirus Species Gamma-12. PLoS One. 2015;10, e138628.View ArticleGoogle Scholar
- Li J, Cai H, Xu Z, Wang Q, Hang D, Shen N, Liu M, Zhang C, Abliz A, Ke Y. Nine complete genome sequences of cutaneous human papillomavirus genotypes isolated from healthy skin of individuals living in rural He Nan province, China. J Virol. 2012;86:11936.View ArticlePubMedPubMed CentralGoogle Scholar
- Donaldson EF, Haskew AN, Gates JE, Huynh J, Moore CJ, Frieman MB. Metagenomic analysis of the viromes of three North American bat species: viral diversity among different bat species that share a common habitat. J Virol. 2010;84:13004–18.View ArticlePubMedPubMed CentralGoogle Scholar
- Sullivan PF, Allander T, Lysholm F, Goh S, Persson B, Jacks A, Evengard B, Pedersen NL, Andersson B. An unbiased metagenomic search for infectious agents using monozygotic twins discordant for chronic fatigue. BMC Microbiol. 2011;11:2.View ArticlePubMedPubMed CentralGoogle Scholar
- Tokarz R, Firth C, Street C, Cox-Foster DL, Lipkin WI. Lack of evidence for an association between Iridovirus and colony collapse disorder. PLoS One. 2011;6, e21844.View ArticlePubMedPubMed CentralGoogle Scholar
- Chan HM, Smith L, La Thangue NB. Role of LXCXE motif-dependent interactions in the activity of the retinoblastoma protein. Oncogene. 2001;20:6152–63.View ArticlePubMedGoogle Scholar
- Dick FA, Dyson NJ. Three regions of the pRB pocket domain affect its inactivation by human papillomavirus E7 proteins. J Virol. 2002;76:6224–34.View ArticlePubMedPubMed CentralGoogle Scholar
- Helt AM, Galloway DA. Mechanisms by which DNA tumor virus oncoproteins target the Rb family of pocket proteins. Carcinogenesis. 2003;24:159–69.View ArticlePubMedGoogle Scholar
- Bottalico D, Chen Z, Dunne A, Ostoloza J, McKinney S, Sun C, Schlecht NF, Fatahzadeh M, Herrero R, Schiffman M, Burk RD. The oral cavity contains abundant known and novel human papillomaviruses from the Betapapillomavirus and Gammapapillomavirus genera. J Infect Dis. 2011;204:787–92.View ArticlePubMedPubMed CentralGoogle Scholar
- Ekstrom J, Bzhalava D, Svenback D, Forslund O, Dillner J. High throughput sequencing reveals diversity of Human Papillomaviruses in cutaneous lesions. Int J Cancer. 2011;129:2643–50.View ArticlePubMedGoogle Scholar
- Foulongne V, Sauvage V, Hebert C, Dereure O, Cheval J, Gouilh MA, Pariente K, Segondy M, Burguiere A, Manuguerra JC, et al. Human skin microbiota: high diversity of DNA viruses identified on the human skin by high throughput sequencing. PLoS One. 2012;7, e38499.View ArticlePubMedPubMed CentralGoogle Scholar
- Ma Y, Madupu R, Karaoz U, Nossa CW, Yang L, Yooseph S, Yachimski PS, Brodie EL, Nelson KE, Pei Z. Human papillomavirus community in healthy persons, defined by metagenomics analysis of human microbiome project shotgun sequencing data sets. J Virol. 2014;88:4786–97.View ArticlePubMedPubMed CentralGoogle Scholar
- Antonsson A, Erfurt C, Hazard K, Holmgren V, Simon M, Kataoka A, Hossain S, Hakangard C, Hansson BG. Prevalence and type spectrum of human papillomaviruses in healthy skin samples collected in three continents. J Gen Virol. 2003;84:1881–6.View ArticlePubMedGoogle Scholar
- Sichero L, Pierce CC, Ferreira S, Sobrinho JS, Luiza BM, Galan L, Silva RC, Lazcano-Ponce E, Giuliano AR, Villa LL. Broad HPV distribution in the genital region of men from the HPV infection in men (HIM) study. Virology. 2013;443:214–7.View ArticlePubMedPubMed CentralGoogle Scholar
- Forslund O, Johansson H, Madsen KG, Kofoed K. The nasal mucosa contains a large spectrum of human papillomavirus types from the Betapapillomavirus and Gammapapillomavirus genera. J Infect Dis. 2013;208:1335–41.View ArticlePubMedGoogle Scholar
- Sichero L, Nyitray AG, Nunes EM, Nepal B, Ferreira S, Sobrinho JS, Baggio ML, Galan L, Silva RC, Lazcano-Ponce E, et al. Diversity of human papillomavirus in the anal canal of men: the HIM Study. Clin Microbiol Infect. 2015;21:502–9.View ArticlePubMedPubMed CentralGoogle Scholar
- Leigh IM, Buchanan JA, Harwood CA, Cerio R, Storey A. Role of human papillomaviruses in cutaneous and oral manifestations of immunosuppression. J Acquir Immune Defic Syndr. 1999;21 Suppl 1:S49–57.PubMedGoogle Scholar